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Managing Low Back Pain A Challen

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									Managing Low Back Pain
A Challenge for the Next
      Millennium
                  OUTLINE
   Incidence of Low Back Pain
   What is Low Back Pain
   Anatomy of Low Back Pain
   Causes of Low Back Pain
   Signs and Symptoms of Low Back Pain
   Diagnosis
   Treatment of Low Back Pain
    (Surgical/Nonsurgical)
   Back Pain Prevention
   Office Chair Selection
     Incidence of Low Back Pain
 Low back pain is one of the main reasons
  Americans visit their doctor
 80% of people will have low back pain at
  some point in their lives Each year, back
  pain costs Americans about $100 billion in
  medical bills, disability, and lost
  productivity.
 It is the most expensive industrial injury,
  affecting 2% to 5% of the workforce and
  leading to 1,000,000 workers'
  compensation claims annually.
     Incidence of Low Back Pain
 Low back pain remains a serious health
  disorder, and, next to the common cold, it
  remains the most common reason why
  people seek medical care
 During his or her life, about one in five
  persons will have a serious episode of
  back pain that will require medical
  attention.
 Low back pain is the most expensive
  health care problem for people age 20 to
  50 years.
                What is Low Back Pain
   Back pain is actually very common—about
    three in four adults will experience back pain
    during their lifetime, especially low back pain
   Back pain may be acute or chronic.
   Back pain comes in many forms, it may be
    sudden and sharp—or it may be dull.
   Pain may occur with movement, and it may
    even occur with coughing and sneezing. You
    may also have numbness in your arms or legs.
   It’s important to treat your back pain properly.
    Seek medical attention if your back pain
    persists—and seek immediate attention if you
    have any of the emergency signs listed below.
        Warning Signs You Need Help
        Pain is getting significantly worse
        Pain affects every day activities
        Severe symptoms
        Groin or leg weakness or numbness
        Arm or hand weakness, tingling, or numbness
        Loss of bowel or bladder control
        Anatomy of Low Back Pain
   Your back, or spine, is made up of many parts
    Your backbone, also called your vertebral column,
    provides support and protection and consists of 33
    vertebrae (bones)
   There are discs between each of the vertebra that
    act like pads or shock absorbers.
   Together, the vertebrae and the discs provide a
    protective tunnel (the spinal canal) to house the
    spinal cord and spinal nerves
   These nerves run down the center of the vertebrae
    and exit to various parts of the body.
Anatomy of Low Back Pain
     Anatomy of Low Back Pain
 Your back also has muscles, ligaments,
  tendons, and blood vessels.
 Muscles are strands of tissues that act as
  the source of power for movement.
 Ligaments are the strong, flexible bands of
  fibrous tissue that link the bones together,
  and tendons connect muscles to bones
  and discs.
 Blood vessels provide nourishment.
 These parts all work together to help you
  move about.
        Anatomy of Low Back Pain
   Back pain may be a result of injury to any or all
    of the previously mentioned body parts
   Injury to the soft tissues (muscles, ligaments,
    tendons) results in sprains or strains, which are
    generally not considered serious
   However, injury to bones, nerves, or blood
    vessels may be more serious
   The outer layers of discs can also get tears or
    cracks, allowing the annulus fibrosus or nucleus
    pulposus to bulge out.
   Any of these injuries can cause inflammation and
    pain.
     Anatomy of Low Back Pain
 The lumbar spine is made up of the lower
  five vertebrae often referred to as L1 to
  L5.
 These five vertebrae line up to give the
  low back a slight inward curve.
 The lowest vertebra of the lumbar spine,
  L5, connects to the top of the sacrum, a
  triangular bone at the base of the spine
  that fits between the two pelvic bones
         Anatomy of Low Back Pain
   Intervertebral discs separate the vertebrae.
   The discs are made of connective tissue.
   Most connective tissue is made of fibers of a material called
    collagen.
   These fibers help the disc withstand tension and pressure.
   Healthy discs work like shock absorbers to cushion the
    spine.
   They protect the spine against the daily pull of gravity.
   They also protect it during strenuous activities that put
    strong force on the spine, such as jumping, running, and
    lifting.
   Two spinal nerves exit the sides of each spinal segment,
    one on the left and one on the right.
   As the nerves leave the spinal cord, they pass through a
    small bony tunnel on each side of the vertebra, called a
    neural foramin
Causes of Low Back Pain
             Back pain has a variety of
              causes, including poor posture
              and poor body mechanics (ex.
              standing for long periods of time
              or sitting incorrectly can cause
              back pain)
             Engaging in certain sports often
              carries a risk of back injury.
             Low back pain is often associated
              with heavy physical work, lifting
              or forceful movement, bending
              or twisting, or awkward
              positions.
             You may even have a back injury
              and not know it until a stressful
              movement aggravates the
              condition.
             Don’t ignore back pain. Talk to
              your doctor if your pain persists.
           Causes of Low Back Pain

   Common Causes of Low Back Pain
    Include:
       Sprain/Strain
       Obesity
       Aging/Degeneration
       Herniation
           Causes of Low Back Pain
   Sprain or Strain:
       A sudden fall, car crash, or sports injury can
        cause a sprain or strain—or even just lifting
        something too heavy.
       When a back injury occurs, muscles,
        ligaments, and tendons can become over-
        stretched, overused, or torn.
       Tissues can swell, causing pain, tenderness,
        and stiffness.
           Causes of Low Back Pain
   Obesity:
       Your spine caries a large portion of your
        weight.
       Being overweight puts pressure and stress on
        the back, especially the low back.
       In addition, carrying excess weight aggravates
        other health conditions such as osteoporosis
        (weak bones), osteoarthritis (joint pain),
        rheumatoid arthritis (an autoimmune disease),
        degenerative disc disease (described below in
        the aging section), spinal stenosis, and
        spondylolisthesis.
        Causes of Low Back Pain
 Degeneration
    The intervertebral disc changes over time.
    The first change that occurs is that the annulus
     around the nucleus weakens and begins to
     develop small cracks and tears
    The body tries to heal the cracks with scar tissue.
    The torn annulus can be a source of pain for two
     reasons. First, there are pain sensors in the outer
     rim of the annulus. They signal a painful response
     when the tear reaches the outer edge of the
     annulus. Second, like injuries to other tissues in
     the body, a tear in the annulus can cause pain due
     to inflammation.
    With time, the disc begins to lose water, causing it
     to lose some of its fullness and height. As a result,
     the vertebrae begin to move closer together.
           Causes of Low Back Pain
   Degeneration
       The intervertebral disc changes over time.
       The first change that occurs is that the annulus
        around the nucleus weakens and begins to
        develop small cracks and tears
       The body tries to heal the cracks with scar tissue.
       The torn annulus can be a source of pain for two
        reasons. First, there are pain sensors in the outer
        rim of the annulus. They signal a painful response
        when the tear reaches the outer edge of the
        annulus. Second, like injuries to other tissues in
        the body, a tear in the annulus can cause pain due
        to inflammation.
       With time, the disc begins to lose water, causing it
        to lose some of its fullness and height. As a result,
        the vertebrae begin to move closer together.
        Causes of Low Back Pain
Degeneration
    The intervertebral disc changes over time.
    The first change that occurs is that the annulus
     around the nucleus weakens and begins to
     develop small cracks and tears
    The body tries to heal the cracks with scar tissue.
    The torn annulus can be a source of pain for two
     reasons. First, there are pain sensors in the outer
     rim of the annulus. They signal a painful response
     when the tear reaches the outer edge of the
     annulus. Second, like injuries to other tissues in
     the body, a tear in the annulus can cause pain due
     to inflammation.
    With time, the disc begins to lose water, causing it
     to lose some of its fullness and height. As a result,
     the vertebrae begin to move closer together.
           Causes of Low Back Pain
   Herniations:
       Herniation occurs when the nucleus in the center
        of the disc pushes out of its normal space.
       The nucleus presses against the annulus, causing
        the disc to bulge outward.
       Sometimes the nucleus herniates completely
        through the annulus and squeezes out of the disc.
       Vigorous, repetitive bending, twisting, and lifting
        can place abnormal pressure on the shock-
        absorbing nucleus of the disc.
       If great enough, this increased pressure can injure
        the annulus, leading to herniation.
       A lumbar disc can also become herniated during
        an acute (sudden) injury
         Causes of Low Back Pain
   Herniation causes pain from a variety of sources.
        Mechanical Pain.
           This is pain that comes from the parts of the spine that
            move during activity, such as the discs and ligaments.
           Pain from inflammation occurs when the nucleus
            squeezes through the annulus.
           The nucleus normally does not come in contact with the
            body's blood supply. However, a tear in the annulus
            puts the nucleus at risk for contacting this blood
            supply.
           When the nucleus herniates into the torn annulus, the
            nucleus and blood supply meet, causing a reaction of
            the chemicals inside the nucleus.
           This produces inflammation and pain.
        Neurogenic Pain
           A disc herniation may also put pressure against a spinal
            nerve.
           Pressure on an irritated or damaged nerve can produce
            pain that radiates along the nerve.
Causes of Low Back Pain
Signs and Symptoms of Low Back Pain

   Disc herniations produce inflammation when the
    nucleus comes in contact with the body's blood
    supply
   The inflammation can be a source of throbbing
    pain in the low back and may spread into one or
    both hips and buttocks.
   A herniated disc can press against a spinal nerve,
    producing symptoms of nerve compression.
   Nerve pain follows known patterns in the lower
    limbs (It can be felt on the side of the upper
    thigh, in the calf, or even in the foot and toes)
   Pressure on the nerve can also cause sensations
    of pins, needles, and numbness where the nerve
    travels down the lower limbs
Signs and Symptoms of Low Back Pain
   Back pain is its own symptom.
   Your back pain may be acute or chronic.
   Acute pain lasts four to six weeks, but chronic pain is persistent,
    long-term pain—sometimes lasting throughout life.
   Back pain may be sudden and sharp—or it may be dull.
   Pain may occur with movement, and it may even occur with
    coughing and sneezing.
   You may also have numbness in your arms or legs. (Leg
    symptoms are often referred to as sciatica caused by a pinched
    nerve.)
   It's important to treat your back pain properly.
   Seek medical attention if your back pain persists—and seek
    immediate attention if you have back pain with any of the
    following emergency signs:
        Pain is getting significantly worse
        Pain affects every day activities
        Severe symptoms
        Groin or leg weakness or numbness
        Arm or hand weakness, tingling, or numbness
        Loss of bowel or bladder control
Signs and Symptoms of Low Back Pain
   Rarely, symptoms involve changes in bowel and bladder
    function.
   A large disc herniation that pushes straight back into the
    spinal canal can put pressure on the nerves that go to the
    bowels and bladder.
   The pressure may cause low back pain, pain running down
    the back of both legs, and numbness or tingling between
    the legs in the area you would contact if you were seated
    on a saddle.
   The pressure on the nerves can cause a loss of control in
    the bowels or bladder.
   This is an emergency. If the pressure isn't relieved, it can
    lead to permanent paralysis of the bowels and bladder.
   This condition is called cauda equina syndrome
   Doctors recommend immediate surgery to remove pressure
    from the nerves.
Signs and Symptoms of Low Back Pain
Signs and Symptoms of Low Back Pain
 In summary, symptoms from low back
  problems vary.
 They depend on a person's condition and
  which structures are affected. Some of the
  more common symptoms of low back
  problems are:
       low back pain
       pain spreading into the buttocks and thighs
       pain radiating from the buttock to the foot
       back stiffness and reduced range of motion
       muscle weakness in the hip, thigh, leg, or foot
       sensory changes (numbness, prickling, or
        tingling) in the leg, foot, or toes
                        Diagnosis
   The diagnosis of low back problems begins with a thorough
    history of your condition.
   Your doctor or therapist will ask you questions to find out
    when you first started having problems, what makes your
    symptoms worse or better, and how the symptoms affect
    your daily activity.
   Your doctor or therapist will then physically examine the
    muscles and joints of your low back.
   It is important that your doctor or therapist see how your
    back is aligned, how it moves, and exactly where it hurts.
   Some simple tests to check the function of the nerves are
    performed.
   These tests are used to measure the strength in your lower
    limbs, check your reflexes, and determine whether you
    have numbness in your legs or feet.
   The information from your medical history and physical
    examination will help your doctor or therapist decide which
    further tests to run.
   The tests give different types of information.
     Treatment of Low Back Pain
 Ninety percent of people who experience
  low back pain for the first time get better
  in two to six weeks without any treatment
  at all.
 Patients often do best when encouraged to
  stay active and to get back to normal
  activities as soon as possible, even if there
  is still some pain.
 The pain may not go away completely.
 One goal of treatment is to help you find
  ways to control the pain and allow you to
  continue to do your normal activities.
             Treatment of Low Back Pain
                   (Nonsurgical)
   Whenever possible, doctors prefer to use treatments other than surgery.
    The first goal of these nonsurgical treatments is to ease your pain and
    other symptoms.
   Bed Rest
        In cases of severe pain, doctors may suggest a short period of bed rest, usually
         no more than two days. Lying on your back can take pressure off sore discs and
         nerves.
        Most doctors advise against strict bed rest and prefer that patients do ordinary
         activities using pain to gauge how much is too much.
   Back Brace
        A back support belt is sometimes recommended when back pain first strikes.
        It can help provide support and lower the pressure inside a problem disc.
        Patients are encouraged to gradually discontinue wearing the support belt over a
         period of two to four days. Otherwise, back muscles begin to rely on the belt and
         start to shrink (atrophy).
   Medications
        Many different types of medications are typically prescribed to help gain control
         of the symptoms of low back pain.
        There is no medication that will cure low back pain.
         Medications are prescribed to help with sleep disturbances and to help control
         pain, inflammation, and muscle spasm.
            Treatment of Low Back Pain
                  (Nonsurgical)
   Physical Therapy and Exercise
       In addition to other nonsurgical treatments, doctors often ask their patients to
        work with a physical therapist.
       Therapy treatments focus on relieving pain, improving back movement, and
        fostering healthy posture.
       A therapist can design a rehabilitation program to address a particular condition
        and to help the patient prevent future problems.
       There is a great deal of scientific proof that exercise and increased overall fitness
        reduce the risk of developing back pain and can improve the symptoms of back
        pain once it begins.
   Injections
       Spinal injections are used for both treatment and diagnostic purposes. T
       here are several different types of spinal injections that your doctor may
        suggest.
       These injections usually use a mixture of an anesthetic and some type of
        cortisone preparation.
       The anesthetic is a medication that numbs the area where it is injected.
       If the injection takes away your pain immediately, this gives your doctor
        important information suggesting that the injected area is indeed the source of
        your pain.
       The cortisone decreases inflammation and can reduce the pain from an inflamed
        nerve or joint for a prolonged period of time.
          Treatment of Low Back Pain
                  (Surgical)
   Only rarely is lumbar spine surgery scheduled right away.
   Your doctor may suggest immediate surgery if you are
    losing control of your bowels and bladder or if your muscles
    are becoming weaker very rapidly.
   For other conditions, doctors prefer to try nonsurgical
    treatments for a minimum of three months before
    considering surgery.
   Most people with back pain tend to get better, not worse.
    Even people who have degenerative spine changes tend to
    gradually improve with time.
   Only one to three percent of patients with degenerative
    lumbar conditions typically require surgery.
   Surgery may be suggested when severe pain is not
    improving.
            Treatment of Low Back Pain
                    (Surgical)
   There are many different operations for back pain. The goal of
    nearly all spine operations is to remove pressure from the nerves
    of the spine, stop excessive motion between two or more
    vertebrae, or both. The type of surgery that is best depends on
    that patient's conditions and symptoms.
   Laminectomy
       removes part or all of the lamina to release pressure on the spinal
        nerves.
   Discectomy
       operation to remove the portion of the disc that is pressing on the
        nerve roots is called a discectomy
       This operation is performed through an incision in the low back
        immediately over the disc that has ruptured.
   Lumbar Fusion
       When there is excessive motion between two or more vertebrae, the
        excess motion can cause both mechanical pain and irritation of the
        nerves of the lumbar spine.
       In this case some type of spinal fusion is usually recommended.
       The goal of a spinal fusion is to force two or more vertebrae to grow
        together, or fuse, into one bone.
       The pain is reduced because the fusion reduces the constant irritation
        and inflammation of the nerve roots
    Back Pain Prevention: 4 Harmful
                Habits
   #1 - Twisting when Lifting
    So many people make this mistake! We
    forget to check our body mechanics while
    lifting, yet too much of this type of
    movement can be very damaging to your
    back. When lifting, follow these steps:
    • Get close to the object
    • Bend your knees and grasp the object firmly
    • Lift straight up (don't twist!) in one fluid motion
    • Hold the object close to your body
    • Move close to where you want to place the object
    • Bend you knees when lowering the object               Wrong!!
    Back Pain Prevention: 4 Harmful
                Habits
   #2 - Bad Posture
    How often to you think about your
    posture?
       Bad posture - slouched shoulders, head
        down, knees locked - places an enormous
        amount of stress on the spine.
       Good posture keeps your body in balance
        and helps avoid that stress. Here's what
        good posture looks like when standing:
         •   Feet slightly apart
         •   Knees straight
         •   Chin slightly tucked in
         •   Shoulders back
       Be sure to check and correct your posture
        during your everyday activities.
       Soon you will find that you are actually more
        comfortable when your spine is in balance!    Stand tall!
    Back Pain Prevention: 4 Harmful
                Habits
   #3 - Too Little Exercise, Too
    Much Weight
       A sedentary lifestyle has become all
        too common in our society today.
       Eventually our spines will pay the
        price.
       Research shows that people who do
        not exercise regularly and are
        overweight are more likely to suffer
        from back injures and pain.
       To keep that from happening to you,
        get up and get moving! Find a way to       Exercise can
        put exercise into your daily activities.   be fun!!
        Not only will it help keep your spine
        healthy, it will help you to shed those
        unwanted pounds and feel great too!
    Back Pain Prevention: 4 Harmful
                Habits
   #4 - Ignoring the Pain
       None of us like going to the doctor, but persistent back
        pain should not be ignored.
       If you suffer from persistent, chronic, or recurring back
        pain, see your doctor.
       In most cases there is an easy, non-surgical treatment
        that can return you to a pain free life.
        However, if left untreated or allowed to progress, back
        pain can lead to serious and severe disability.




                                Don't ignore unresolved pain
              Back Pain Prevention
   Tips to Minimize Stress at the Desk
       Don't lean over the desk for prolonged periods
        of time
       Don't sit too far from the work and/or with the
        back unsupported.
       Raise or lower the chair to the proper height so
        the knees are bent at a 90-degree angle.
       Keep the elbows bent at a 90-degree angle.
        The elbows may rest on the work surface.
       Don't bend or twist the neck to cradle the
        phone against the shoulder.
              Back Pain Prevention
   How To Maintain a Neutral Spine
    While Standing
       The feet should be placed slightly apart with
        the knees straight and chin tucked in to
        maintain a neutral spine.
       Do not stand in one position for a prolonged
        period of time; shift the weight from one foot
        to the other frequently.
       Use a footstool to elevate each foot from time
        to time may be helpful.
               Back Pain Prevention
   Spine Safety – Carrying
       First take a look at the object to be moved. If it appears
        to be too heavy or cumbersome, find help! Next,
        consider where the object is going. Are there obstacles
        along the way? If so, move them out of the pathway.
       Depending on the shape of the object, try to hold it at
        the side and bottom while keeping it close to the body.
        Remember to keep the back straight. Carry the object
        with the elbows slightly bent.
       An extra tip ... Carry a balanced amount of weight in
        each hand. For example, when carrying shopping bags
        or luggage, split the load in two.
       The shoulders should be held slightly back and level.
       Each ear should line up with the shoulders.
       The chin is slightly tucked and the pelvis is shifted
        forward so the hips are aligned with the ankles.
              Back Pain Prevention
   Spine Safety – Lifting
       First take a look at the object to be moved. If
        it appears to be too heavy or cumbersome,
        find help!
       If there are obstacles in the way, move them
        before lifting the object.
       Maintain good posture and keep the head
        properly aligned. Try to get as close to the
        object as possible and bend at the knees.
                Back Pain Prevention
   Spine Safety - Reaching
       Consider the size, weight, and location of the object. Use a
        sturdy stool or ladder if necessary. Don't even think about
        standing on tiptoe!
       Next, directly face the object and get as close to it as possible.
        One hand could be used for additional support. Try not to look
        overhead for prolonged periods of time. This could cause
        unnecessary stress to the neck.
       An extra tip ... Store items that are used often within easy
        reach. This may mean rearranging shelves and/or closets.
       Don't lift yet! Make sure the feet are slightly apart and flat on
        the floor. To turn, instead of twisting the body, pivot with the
        feet. This will help to provide a stable base of support.
       Keep breathing and tighten the stomach muscles. Smoothly lift
        the object using the arms and legs ... not the back!

Remember ...Poor posture and incorrect body mechanics are
  two of the leading causes of neck and back pain
               Back Pain Prevention
   What is the correct way to sit?
       Keep your feet flat on the floor.
       Try to avoid sitting in the same position for more than
        30 minutes.
       At work, adjust your chair height and work station so
        you can sit up close to your work and tilt it up at you.
        Rest your elbows and arms on your chair or desk,
        keeping your shoulders relaxed.
       When sitting in a chair that rolls and pivots, don't twist
        at the waist while sitting. Instead, turn your whole body.
       When standing up from the sitting position, move to the
        front of the seat of your chair. Stand up by straightening
        your legs. Avoid bending forward at your waist.
        Immediately stretch your back by doing 10 standing
        backbends.

    It is ok to assume other sitting positions for short periods of
    time, but most of your sitting time should be spent as
    described above so there is minimal stress on your spine.
                Back Pain Prevention
   What is the correct way to sit? (Cont’d)
       Sit up with your back straight and your shoulders back. Your
        buttocks should touch the back of your chair.
       All three normal back curves should be present while sitting. A
        small, rolled-up towel or a lumbar roll can be used to help you
        maintain the normal curves in your back.
       Here's how to find a good sitting position when you're not
        using a back support or lumbar roll:
          a. Sit at the end of your chair and slouch completely
          b. Draw yourself up and accentuate the curve of your
              back as far as possible.
          c. Hold for a few seconds
          d. Release the position slightly (about 10 degrees).
             This is a good sitting posture.
       Distribute your body weight evenly on both hips.
       Bend your knees at a right angle. Do not sit with your knees
        crossed. Keep your knees even with or slightly higher than
        your hips.
             Back Pain Prevention
   What is the correct way to sit while driving?
       Use a back support (lumbar roll) at the curve
        of your back. Your knees should be at the
        same level or higher than your hips. "
       Move the seat close to the steering wheel to
        support the curve of your back. The seat
        should be close enough to allow your knees to
        bend and your feet to reach the pedals.
               Back Pain Prevention
   What is the best position for sleeping and
    lying down?
       The best lying or sleeping position may vary, depending
        on your symptoms. No matter what position you lie in,
        the pillow should be under your head, but not your
        shoulders, and should be a thickness that allows your
        head to be in a normal position. "
       Try to sleep in a position which helps you maintain the
        curve in your back (such as on your back with a pillow
        under your knees or a lumbar roll under your lower
        back; or on your side with your knees slightly bent). Do
        not sleep on your side with your knees drawn up to your
        chest. You may want to avoid sleeping on your stomach,
        especially on a saggy mattress, since this can cause
        back strain and can be uncomfortable for your neck.
               Back Pain Prevention
   What is the best position for sleeping and
    lying down? (Cont’d)
       Select a firm mattress and box spring set that does not
        sag. If necessary, place a board under your mattress.
        You can also place the mattress on the floor temporarily
        if necessary. If you've always slept on a soft surface, it
        may be more painful to change to a hard surface. Try to
        do what's most comfortable for you.
       Try using a back support (lumbar support) at night to
        make you more comfortable. A rolled sheet or towel tied
        around your waist may be helpful.
       When standing up from the lying position, turn on your
        side, draw up both knees and swing your legs on the
        side of the bed. Sit up by pushing yourself up with your
        hands. Avoid bending forward at your waist.
    Office Chair Selection: 9 Ergonomic
                    Tips
   1. Height Adjustment
       Easily raises or lowers the seat to bring your
        hips and torso to the correct 90 degree sitting
        position appropriate for the level of your work
        area.
       With both feet flat on the floor and knees bent
        at a comfortable angle, your lower legs are
        supported without putting pressure on your
        thighs.
    Office Chair Selection: 9 Ergonomic
                    Tips
   2. Angle Adjustment
       Can be at the back, seat or both, and allows
        you to change the angle between your torso
        and thighs.
       Puts you in the correct neutral position to
        support and maintain the natural curve of your
        spine.
    Office Chair Selection: 9 Ergonomic
                    Tips
   3. Seat Pan
       The seat pan should be at least once inch wider than
        your hips and thighs on either side, and should not be
        too long for your legs.
       Chairs with seat slider adjustments can accommodate
        users of almost any side.
       A contour seat is highly recommended for proper
        distribution of weight over the seat's surface to reduce
        fatigue and leg pain and allow you to sit for extended
        periods.
    Office Chair Selection: 9 Ergonomic
                    Tips
   4. Adjustable Tilt and Tension Control
       Allows you to regulate the angle support, from
        locked in place to free floating.
       Especially useful for multi-tasking, and to help
        maintain support as you lean into/away from
        your desk throughout the day.
    Office Chair Selection: 9 Ergonomic
                    Tips
   5. Backrest
       Proper support can be achieved by height
        adjustment to the backrest of your chair, or
        the backrest can be adjusted to support the
        contour of your back as well as your neck and
        shoulders
    Office Chair Selection: 9 Ergonomic
                    Tips
   6. Memory Foam
       Energy absorbent memory foam (including
        LIFE-Foam® and WonderFoam®) conforms to
        your body's contours providing gentle, virtually
        pressure-free support, thereby improving
        posture and reducing stress.
    Office Chair Selection: 9 Ergonomic
                    Tips
   7. Adjustable Armrests
       To achieve the proper neutral position for
        wrists and arms, consider these 3 factors:
            Height Adjustment helps relieve fatigue in neck and
             shoulders;
            Width Adjustment increases support in coordination
             with your shoulder span and the task at hand;
            Pivoting/Articulating armrests rotate or swivel,
             allowing you to maintain a relaxed position despite
             your movements.
    Office Chair Selection: 9 Ergonomic
                    Tips
   8. Lumbar Support
       Provides support to the lower back (lumbar
        region) which encourages correct sitting
        posture to reduce strain on the vertebral disks.
        Improves relaxation and prevents back pain.
    Office Chair Selection: 9 Ergonomic
                    Tips
   9. Cervical Support
       Offers support and relieves pressure on your neck and
        shoulder (cervical region) especially when leaning back.
        Support is provided by either an attached headrest or
        high back chair.
       The key is to maintain good posture while sitting. But
        it's more than just sitting up straight. Check out your
        posture right now, are your:
       Feet flat on the floor (not crossed or tucked under you)?
       Back and shoulders against the backrest of the chair?
       Elbows and lower arms resting lightly on the armrests?
       Shoulders relaxed and slightly dropped (not hunched
        forward)
    Office Chair Selection: 9 Ergonomic
                    Tips
   9. Cervical Support
       Offers support and relieves pressure on your neck and
        shoulder (cervical region) especially when leaning back.
        Support is provided by either an attached headrest or
        high back chair.
       The key is to maintain good posture while sitting. But
        it's more than just sitting up straight. Check out your
        posture right now, are your:
       Feet flat on the floor (not crossed or tucked under you)?
       Back and shoulders against the backrest of the chair?
       Elbows and lower arms resting lightly on the armrests?
       Shoulders relaxed and slightly dropped (not hunched
        forward)
    Office Chair Selection: 9 Ergonomic
                    Tips
   9. Cervical Support (Cont’d)
      Hips slightly higher than your knees?
     Knees bent comfortably (there should be 2-4 inches
       between the back of your knees and the edge of the
       chair)?
     Eyes facing the computer screen?
    It is important that all three normal back curves be
       present while you are sitting, especially for people who
       sit for long periods of time.
    A small, rolled-up towel or a lumbar support pillow is a
       great way to help you maintain good sitting posture and
       avoid spinal stress.
    THANK YOU FOR YOUR TIME!!!
   Any Questions?

								
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